TRANSCULTURAL NURSING

Prepared by: Mrs. Soumya.R

 INTRODUCTION
Transcultural nursing is a humanistic
and scientific area of nursing study and practice that focus
on how patterns of behavior in health, illness and caring are
influenced by the values and beliefs of specific cultural
groups. In the health care delivery system, as in society, the
nurse interacts with people of similar and diverse cultural
backgrounds. People may have similar or different frames of
reference and varied preferences regarding their health and
health care needs. To plan and deliver culturally competent
care, the nurse must understand the definitions of culture
and cultural competence and the various aspects of culture
that should be explored for each patient.

I DEFINITION

A humanistic and scientific area of formal study and practice in

nursing which is focused upon comparative differences and
similarities among cultures with respect to human care, health,
and illness based upon the people's cultural values, beliefs, and
practices, and to use this knowledge to provide cultural specific
or culturally congruent nursing care to people.
- ( Leininger)

II . GOAL OF TRANSCULTURAL
NURSING
The goals of Transcultural nursing are:
1. To give culturally congruent nursing care.
The main goal of transcultural nursing is to give culturally
congruent nursing care. The ability to provide culturally
competent care is especially important for critical care nurses,
who function in high-acuity, high-stress healthcare
environments. Critical care nurses must develop cultural
competency to be effective in establishing rapport with
patients, and to accurately assess, develop, and implement
nursing interventions designed to meet patients’ needs.

2. To provide culture specific and universal nursing care

practices for the health and well-being of people.
The ultimate aim of nurses is to give highly efficient nursing
care. The nurses are required to support decisions made by
patients or patients’ families that may reflect a cultural
perspective that conflicts with mainstream healthcare
practices. In today’s society, culturally competent care cannot
be offered to all patients unless nurses have a clear
understanding of diverse cultural backgrounds.

3. To aid them in facing adverse human conditions,

illness or death in culturally meaningful ways:
According to Leininger, the goal of transcultural nursing care is
to preserve, accommodate or re pattern the cultures of the
patient. The nurses respect the culture of the patients and work
hard for their wellness. Through transcultural nursing, the
nurses helps the patients to cope up with every situation in
proper and meaningful way.

IV. HISTORICAL PERSPECTIVES

The transcultural nursing has its roots in the early 1900‘s when
public health nurse cares for immigrants from Europe who
came from a wide range of cultural background and had diverse
health care practices. During the 19th century, the words come
to be used almost interchangeably with civilization. This
civilization or culture was something achieved as society is
evolved.
Dr. Madeleine Leininger is the foundress of the worldwide
Transcultural nursing movement. She remains as one of
nursing' most prolific writers and the foremost authority
throughout the world in the field of cultural care. Madeleine
Leininger's theory of Transcultural nursing, also known as
Culture Care Theory, falls under both the category of a
specialty, as well as a general practice area. The theory has now
developed into a discipline in nursing.
Belief‘s practices and life ways passed down from one
generation to next. The idea the culture and care are
inextricably linked, led her to study other cultures and she
become the first nurse to obtain a doctorate in anthropology.
Transcultural nursing is a body of knowledge and practice for
caring the people from other cultures. Many nurse leader and
educators have embraced the need for culture specific care,
and various approaches to gaining this knowledge have been
developed.

CHANGING CONCEPT OF
TRANSCULTURAL NURSING
Transcultural Nursing is a humanistic and scientific area of
formal study and practice in nursing which is focused upon
differences and similarities among cultures with respect to
human care, health, and illness based upon the people's
cultural values, beliefs, and practices, and to use this
knowledge to provide cultural specific or culturally congruent
nursing care to the people. Leininger (1991) notes the main
goal of transcultural nursing is to provide culturally specific
care. But before transcultural nursing can be adequately
understood, there must be a basic knowledge of key
terminology such as culture, cultural values, culturally diverse
nursing care, ethnocentrism, race and ethnography.
Culture refers to norms and practices of a particular group that
are learned and shared and guide, thinking, decisions and
actions. Culture is learned by each generation through both
formal and informal life experiences and language is primary
through means of transmitting culture. Culturally diverse
nursing care is an optimal mode of health care delivery, refers
to the variability of nursing approaches needed to provide
culturally appropriate care

VI. IMPORTANCE OF
TRANSCULTURAL NURSING
Cultural background affect a person's health in all
dimensions, so the nurse should consider the client's
cultural background when planning care Although basic
 human needs are the same for all people, the way a
person seeks to meet those needs is influenced by culture.

 To heighten awareness of their faith system provides

resources for that:
The transcultural nursing aims to make growing awareness
acceptance of diversity and willingness to maintain and support
ethnic and cultural heritage. The cultural belief has a greater
influence in one’s life. When dealing with patients belonging to
different cultures, the nurse needs to take careful attention.
To foster understanding, respect and appreciation for the
individuality and diversity of patients beliefs, values, spirituality
and culture regarding illness, its meaning, cause, treatment,
and outcome.

 To encourage patient oriented care:

Transcultural nursing strengthen their commitment to

relationship-centered medicine that emphasizes care of the
suffering person rather than attention simply more to the
pathophysiology of disease, and recognizes the physician as a
dynamic component of that relationship.

 To facilitate spiritual beliefs:

It facilitates in recognizing the role of the hospital chaplain and
the patient's clergy as partners in the health care team in
providing care for the patient

 To facilitate complete physical, social and mental

wellbeing:
The transcultural nursing encourage in developing and
maintaining a program of physical, emotional and spiritual self-
care and introduce therapies from the East such as ayurveda
and panchakarma.

VII. PROCESS INVOLVED IN CULTURAL

COMPETENT CARE
The terms cultural awareness, cultural sensitivity and cultural
competence are often used interchangeably; however, they are
different.

a)Cultural awareness

Cultural awareness is a conscious learning process in

which an individual becomes appreciative of and sensitive
to the cultures of other people.

b) Cultural knowledge
 Cultural knowledge involves the process of understanding
the key aspects of a group’s culture, especially as it relates
to health and health care practices. Cultural groups can
have differences in (1) beliefs about the cause of illness
and health, (2) the appropriate use of various treatments
and healers, (3) beliefs about lengths of recovery or
convalescence, and (4) sick role behavior.

c) Cultural skill
Cultural skill refers to the ability to collect relevant cultural
data regarding health histories and performing culturally
specific assessments. Providing culturally competent care
increases patient satisfaction, reduces health disparities,
and prevents misunderstanding between nurses and
patients.

d) Cultural encounter
Cultural encounter is essential for the development of
cultural competence and refers to direct cross-cultural
interactions between people from culturally diverse
backgrounds. Cultural competence requires extended
contact with persons from different cultures and learning
how their cultural beliefs and practices affect their health
and health care practices. Through experience with
 members of a culture, the nurse can become more
competent in caring for them.

VIII. CULTURAL ASSESSMENT

Cultural assessment is a systematic and comprehensive
examination of the cultural care values, beliefs, and practices of
individuals, families, and communities. Goal of cultural
assessment is to gather significant information from the client
that will enable the nurse to implement culturally congruent
care.

a) Brief history
Encourage clients to describe values, beliefs, and practices
that are significant to their care that health care providers
Identify client’s health risks related to socio cultural and
biological history on admission. Knowledge of a client’s
country of origin and its history and ecological contexts
are significant to health care. Some distinct health risks
are due to the ecological context of the culture.

b) Communication
Different cultural groups have distinct linguistic and
communication patterns. These patterns reflect core cultural
values of a society. In the dominant American culture that
supports individualism, people value assertive
communication because it manifests the ideal of individual
autonomy and self-determination. Culture also shapes
nonverbal communication. Culture influences the distance
between participants in an interaction, the degree of eye
contact, the extent of touching, and how much private
information the client will share. Clients use less distance
when speaking to trusted insiders and persons of the same
age, gender, and position in the social hierarchy. To
minimize this distance when communicating with client’s
nurses need to establish rapport and behave in a culturally
congruent manner through impression management.

c) Beliefs and values

Three views of health beliefs include magico-religious,
scientific, and holistic. In the magico - religious health belief
view, health and illness are controlled by supernatural
forces. The client may believe that illness is the result of
“being bad” or opposing the creator’s will.
The scientific or biomedical health belief is based on the
belief that life is controlled by physical and biochemical
processes that can be manipulated by humans. The client
with this view will believe that illness is caused by germs,
viruses, bacteria, or a breakdown of the body. This client will
expect a pill, treatment or surgery to cure health problems.
Concept of yin and yang (in the Chinese culture) and the hot-
cold theory of illness in many cultures (such as Middle
Eastern, Spanish, and Asian) are examples of holistic health
beliefs. When a Chinese client has a yin illness or a
“cold”illness such as cancer, the treatment may include a
yang or “hot” food (eg. hot tea).
If the family’s total income is less than that family’s
threshold, all members of the family are considered poor.
The amount of money a person or family has affects how
they meet their basic needs and maintain their health.
Poverty leads to other problems such as lack of health
insurance, care of infants and children, and homelessness.
Poverty cultures have the following characteristics:
• Feelings of despair, resignation, and fatalism
• Day-to-day attitude toward life, with no hope for the
future.
• Unemployment and need for financial or government aid.
• Unstable family structure, possibly characterized by
abusiveness and abandonment.
• Decline in self-respect and retreat from community
involvement.

e) Nutrition
Food preferences and how foods are prepared often are
related culturally. Certain food groups serve as staples of the
diet based on culture and remain so even when members of
that culture are living in a different country. Patients in a
hospital or long-term care setting often do not have much
choice of foods. This means that people with cultural food
Preferences may not be able to select appealing foods and
thus may be at risk for inadequate nutrition. When assessing
the cause of decreased appetite in patients, try to determine
whether the problem may be related to culture. It may be
possible for family or friends to bring in foods that satisfy
the patient’s nutritional needs while still meeting dietary
restrictions.
Religious beliefs are evident in clients dietary practices.
Devout Hindus avoid beef, and many are vegetarians. Many
Buddhists are vegetarians. The nursing staff needs to have
background information available about major holy days
and practices for commonly encountered religions.

d) Socioeconomic Considerations
The amount of money a person or family has affects how
they meet their basic needs and maintain their health.
Poverty leads to other problems such as lack of health
insurance, care of infants and children, and homelessness.
All these areas are of concern to nursing.
The increasing population of older people has also raised
problems associated with poverty. Many older people live on
fixed incomes that often do not keep up with inflation, and
many (particularly widows) are on the borderline of poverty
or have already slipped below the poverty level. Poverty
cultures have the following characteristics:
• Feelings of despair, resignation, and fatalism
• Day-to-day attitude toward life, with no hope for the
future.
• Unemployment and need for financial or government aid.
• Unstable family structure, possibly characterized by
abusiveness and abandonment.
• Decline in self-respect and retreat from community
involvement.

e) Nutrition
Food preferences and how foods are prepared often are
related culturally. Certain food groups serve as staples of the
diet based on culture and remain so even when members of
that culture are living in a different country. Patients in a
hospital or long-term care setting often do not have much
choice of foods. This means that people Patients in a hospital
or long-term care setting often do not have much choice of
foods. This means that people with cultural food le with
cultural food
Preferences may not be able to select appealing foods and
thus may be at risk for inadequate nutrition. When assessing
the cause of decreased appetite in patients, try to determine
whether the problem may be related to culture. It may be
possible for family or friends to bring in foods that satisfy
the patient’s nutritional needs while still meeting dietary
restrictions.

f) Traditional remedies
The HEALTH traditions model (Specter, 2009) is predicated
on the concept of holistic health and describes what people
do from a traditional perspective to maintain, protect, and
restore health. In this context, the term traditional refers to
those customs, beliefs, or practices that have existed for
many generations without changing. The HEALTH tradition
model, consists of nine interrelated facets, represented by
the following:
Traditional methods of restoring HEALTH - physical, mental
and spiritual. It may include the use of herbal remedies,
exorcism, and healing rituals.

g) Educational background
In our society, there are literate and illiterate people. It is the
right of every individual to receive nursing care. Education is
the process of facilitating learning or the acquisition of
knowledge, skills, values, beliefs, and habits. The care giver
must give equal care to all the people irrespective of age,
gender, race, education, occupation etc. Before doing any
procedure, the care giver must explain about the procedure
in their local language.

h) Spiritual considerations
Spiritual beliefs are major influences in the client’s
worldview about health and illness, pain and suffering and
life and death. Nurses need to anticipate the ritual cleansing
needs of the client and provide privacy for praying. For
example, reschedule diagnostic procedures so that Buddhist
clients are able to participate in the festivities of their new
year.

i) Family roles
The family is considered the basic unit of society. Cultural
values greatly influence communication patterns within the
family group, the norm for family size and the roles of
specific family members. The nurse needs to identify who
has the authority to make decisions in a client’s family. If the
decision maker is someone other than the client, the nurse
needs to include that the nurse should evaluate the positive
benefits of family participation in the client’s care and adapt
visiting policies as appropriate. The nurse must person in
health care discussions.
This attitude can present difficulties for health care
professionals who require knowledge of family interaction
patterns to help clients with emotional problems.

j) Gender roles
In many cultures, the man is the dominant figure and
generally makes decisions for all family members. For
example, if approval for medical care is needed, the man
gives it regardless of which family member is involved. In
male-dominant cultures, women are usually passive. On the
other hand, in many African American and Caucasian
families, the woman is often dominant. Knowing who the
dominant member of the family is important when planning
nursing care. For example, if the dominant member is ill and
can no longer make decisions, whole family may be anxious
and confused. If a non dominant family member is ill, he or
she may require help in verbalizing needs, particularly if
they differ from those the dominant member perceives as
being important.
k) Time orientation
All cultures have past, present, and future time dimensions.
It is important for nurses to understand their client’s time
orientation. This information is useful in planning a day of
care, setting up appointments for procedures, helping a
client plan self-care activities in the home. Differences exist
in the dimensions of time that cultures emphasize and the
manner of expressing time.

l) Personal space
Personal space is the area around a person regarded as part
of the person. This area, individualized to each person and to
different cultures and ethnic groups, is the area into which
others should not intrude during personal interactions. For
example, people of Arabic and African origin commonly sits
and close to one another when talking, whereas people of
Asian and European descent are more comfortable with
some distance between themselves and others.

IX. cultural CARE THEORY BY LEININGER

Sunrise Model theory

Effective care is the ultimate task of nurses. We are the
members of the health team who have direct patient/client
interaction and therefore it is through our knowledge &
understanding of the values, customs, beliefs & practices our
patients’ culture that we can provide effective care. A better
way of understanding the factors that influence a person’s
perception of well-being is the sunrise enabler of Madeleine
Leininger. Leininger’s model of cultural care can be viewed
as a rising sun. When using this model, the nurse can begin
anywhere depending on the focus of nursing assessment.
The model reflects influences of one’s worldview on cultural
and structure dimensions. The cultural and social structure
dimensions include technological, religious, philosophic,
kinship, social, value and life way, political, legal, economic,
and educational factors. Each of these identified systems
affects health. These cultural and social structure
dimensions in turn influences environment and language,
wherein emphasis should be placed since this is where the
patient/client find themselves such as home conditions,
access to particular types of food and family access to
transport.
Environment and language influence the involved health
systems – the folk, professional and nursing systems. The
folk health system includes the traditional beliefs and
practices on health care while the professional health
systems are those practices we learned cognitively through
formal professional schools of learning. The combination of
the folk health system and the professional health system
meets the biological, psychosocial, and cultural health needs
of the patient/client.
These factors influence the patterns and expressions of
caring in relation to the health of individuals, families,
groups, and communities. To be able to make sound nursing
care decisions and actions, these factors should be assessed
properly and always be taken into consideration. Next level
explains nursing care. It has three modes. First one is
nursing care preservation; in this the nurse helps the patient
and family to preserve the health in terms of values and
believes. In second include, nurse care accommodation or
negotiation. In this the nurse will negotiate how they can
maintain a good health with the help of cultural values and
believes. And then re-patterning and restructuring cultural
believes to maintain a healthy life.

xi. NURSES ROLE IN TRANSCULTURAL

NURSING
 Determine the client's cultural heritage and language
skills.
 Determine if any of his health beliefs relate to the cause of
the illness or to the problem.
 Collect information that any home remedies the person is
taking to treat the symptoms.
 Nurses should evaluate their attitudes toward ethnic
nursing care.
 Self-evaluation helps the nurse to become more
comfortable when providing care to clients from diverse
backgrounds.
 Understand the influence of culture, race &ethnicity on the
development of social emotional relationship, child
rearing practices & attitude toward health.
 Collect information about the socioeconomic status of the
family and its influence on their health promotion and
wellness
 Identify the religious practices of the family and their
influence on health promotion belief in families.
 Understandings of the general characteristics of the major
ethnic groups, but always individualize care.
 The nursing diagnosis for clients should include potential
problems in their interaction with the health care system
and problems involving the effects of culture.
 The planning and implementation of nursing
interventions should be adapted as much as possible to
the client's cultural background.
 Evaluation should include the nurse's self-evaluation of
attitudes and emotions toward providing nursing care to
clients from diverse socio cultural backgrounds.
 Self-evaluation by the nurse is crucial as he or she
increases skills for interaction.      .
CONCLUSION
 Nurses need to be aware of and sensitive to the cultural
needs of clients. The practice of nursing to The practice
of nursing today demands that the nurse identify and
meet the cultural needs of diverse groups, understand
the social and cultural reality of the client, family, and
community, develop expertise to implement culturally
acceptable strategies to provide nursing care, and
identify and use resources acceptable to the client